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Biomedical subjects

D Bell

Publications and source records attributed to D Bell.

261 records · Page 15Linked to original sources
PubMedDate not supplied

Insulin antibodies in non-insulin-dependent diabetes mellitus: effect of treatment with semisynthetic human insulin.

This multicenter study of patients with non-insulin-dependent diabetes mellitus (NIDDM) was undertaken (1) to determine the incidence of insulin antibody formation in such patients before exposure to exogenous insulin; (2) to assess the long-term immunologic response to semisynthetic human insulin (ssHI) in new insulin users and in patients transferred from animal insulin; and (3) to document the efficacy and safety of ssHI in both new and transfer patients. In addition, a substudy at one participating center was designed to compare the effects of a twice-daily versus a once-daily regimen in initiating ssHI therapy in new patients with uncontrolled NIDDM. Among the 37 new patients, only one had detectable insulin antibody levels before administration of insulin. After ssHI therapy was begun, this patient's antibody levels rapidly fell below the assay's limit of detection. Detectable levels of antibodies to human insulin were found in only 36% of 28 new patients after 12 months of therapy. As expected, the prevalence of insulin antibodies among animal-insulin users was high: 82% of the 17 transfer patients had detectable insulin antibody levels (mean, 2.27 mU/ml) at baseline. After six months of treatment with ssHI, antibody levels decreased significantly (mean, 0.75 mU/ml; P less than 0.05). Control of glycemia was assessed by measurement of glycosylated hemoglobin. Values decreased significantly (P less than 0.01) in the new patients after the introduction of ssHI and remained stable in the transfer group after initiation of ssHI therapy. Hypoglycemic episodes were infrequent in both groups. In initiating ssHI therapy in new patients hospitalized with uncontrolled NIDDM, a twice-daily regimen resulted in a more rapid normalization of glycemia and earlier discharge than did the standard once-daily regimen. In conclusion, the results of this study provide further evidence that NIDDM and insulin-dependent diabetes mellitus (IDDM) are immunologically different disorders, with the immune system probably not involved in the pathogenesis of NIDDM. The data also indicate that ssHI is less immunogenic than animal insulin and that it is effective and safe in the management of NIDDM both in first-time insulin users and in patients transferred from animal-species insulin. Thus ssHI would appear to be useful in treating NIDDM, especially in patients who require intermittent insulin therapy.

Diabetes Mellitus, Type 2↗
PubMedDate not supplied

Education in primary prevention in psychiatric-mental health nursing for the baccalaureate student.

The concept of primary prevention is discussed, as it has traditionally and recently been used in reference to mental health and mental illness, as an introduction to the description of a course concerned with primary prevention in psychiatric-mental health nursing. The course, developed for senior baccalaureate nursing students, included both a didactic and a clinical component, is reviewed and the evaluation outcomes are discussed. The paper concludes with a call for nursing to enhance its concern for prevention of mental illness and promotion of mental health.

Curriculum↗
PubMedDate not supplied

[The regulatory mechanisms of glomerular filtration: the tubuloglomerular feedback system, physiological aspects and their participation in the physiopathology of kidney diseases].

The tubuloglomerular feedback system (TGF), the main component of the autoregulation mechanism, maintains constant glomerular blood flow and filtration rate. The system is based in the morpho-functional association among the macula densa, the afferent and efferent arterioles, the glomerulus and the extraglomerular mesangial cells. The macula densa cells sense the changes in solute concentrations and osmolarity in the tubular fluid and send vasoconstrictor or vasodilatory signals to the arterioles that modify blood flow and glomerular filtration rate. However, the mechanism by which the macula densa sends signals to the arterioles remains unknown. A chemical mediator such as prostaglandins or adenosine has been postulated. Our studies discarded the participation of prostaglandins as mediators. Further studies from our group with adenosine analogs indicate that this nucleotide participates in the activation of the TGF responses, and suggest alternate activation pathways not previously described. To evaluate the role of TGF feedback in the glomerular hemodynamic changes associated with progression of renal damage, we studied TGF responses in rats with Goldblatt hypertension and partial ablation of the contralateral kidney. Our results suggest that the sensitivity of the system is decreased. This alteration may contribute to glomerular hypertension and progression to renal damage.

Adenosine↗